Vital Investments: Access to Coverage and Care

In light of expected changes to healthcare delivery and access under the incoming presidential administration, the American Psychology Association, the Equitas Foundation, and a coalition of stakeholders have released a consensus letter recommending that comprehensive approaches “to addressing issues at the intersection of behavioral health and criminal justice” be adopted by the Trump Administration and members of the 115th Congress.

Despite decades of reform and innovation, significant gaps remain in coverage and access to care for people living with mental health challenges. These persistent gaps in coverage and care, and uncertainties about quality of care, carry serious consequences for all of us.

Access to quality care for mental and behavioral health is too often the exception rather than the rule. When left untreated, as nearly 60% of people with mental illnesses are, individuals may find themselves in dangerous situations–more likely to be victims of violence, more likely to engage in risky behaviors, more likely to commit low-level crimes like loitering or shoplifting, and more likely to end up in jail than in a hospital. Failure to close the gaps in the system and provide access to care for so many comes at great cost to their quality of life—and ours—inasmuch as it increases the likelihood of over-reliance on expensive emergency services, decreases economic productivity, and needlessly jeopardizes public safety.

The answer to reducing costs for taxpayers and promoting healthy individuals and communities is not continued costly mass incarceration and endless recycling through the strained legal system, but upstream prevention and early access to care. When people experiencing mental illness and behavioral health challenges receive timely access to quality, person-centered care–which might include behavioral therapy, treatment for co-occurring disorders, medication, and stable, wraparound housing depending on need–their outcomes can measurably improve. Providing Assertive Community Treatment in Los Angeles has been found to cost two-fifths of what is spent on jail stays, and results in significantly superior outcomes.

Right now, the best practice in providing cost-effective mental and behavioral health care is Medicaid expansion. High costs and scarcity of quality services too often bar people in crisis from getting the help they need. With expanded access to care through Medicaid, Americans in crisis will be more likely to hold on to housing and jobs, retain their self-sufficiency, and be able to continuously manage their symptoms until they get back on their feet, ready to participate in their local economy and community. Without the safety net Medicaid provides, the likelihood of passing unnecessarily elevated financial and social costs on to communities is certain.

While continuing to advocate for access to high quality preventive health care and public safety officer training and transformation, Equitas joins prominent national partners in recommending ways for the new administration and Congress to support state and local efforts to reduce ineffective spending within the legal system and better promote health, justice, and prosperity for all.

The Affordable Care Act set in motion the expanded access to health care that had been a national priority for decades, and that is essential to our prosperity and wellbeing. It is far from perfect, and has well-informed critics on all sides. But it is an important step, and has guided changes in thinking about the cost-effectiveness of preventive interventions and the sensibility of demanding that our goals for behavioral health care be on equal footing with, and inextricable from, our goals for health care generally in terms of access, coverage, and quality.

Complete and successful health care reform requires additional acts of Congress and administrative decisions. Equitas joins our partners in urging the Trump administration and 115th Congress to consider the poor social and economic outcomes resulting from ongoing mismanagement of mental and behavioral health through the legal system, and to make investments in mental health care that will make the U.S. the world’s healthiest nation, and produce future prosperity and demonstrated financial returns for states and localities across the country.